West Virginia Chapter of ACHE Physician – Hospital Integration The Second Wave James W. Thomas, Esquire 500 Virginia Street, East, Suite 1600 Charleston, WV Phone: (304) Fax: (304)

w w w. j a c k s o n k e l l y. c o m 2 First Wave of Integration Physician practice acquisition Physician hospital organization (PHO) Management services organization (MSO) Preferred provider organization (PPO) Health maintenance organization (HMO)

w w w. j a c k s o n k e l l y. c o m 3 First Wave of Integration Physicians paid too much money Unrealistic performance expectations Physicians excluded from leadership Lack of hospital know-how to manage physician practices Superficial integration

w w w. j a c k s o n k e l l y. c o m 4 Second Wave of Integration Reimbursement changes favoring bundled payment and payment for performance Declining reimbursement levels/need for bargaining power Emphasis on community health Digitalization of medical records Cultural changes in workforce

w w w. j a c k s o n k e l l y. c o m 5 Second Wave of Integration Call coverage arrangements Physician employment Professional service agreement Physician-hospital joint venture

w w w. j a c k s o n k e l l y. c o m 6 Second Wave of Integration Co-management arrangement Gainsharing arrangement PHO Accountable care organization (ACO)

w w w. j a c k s o n k e l l y. c o m 7 Legal Challenges for Integration Anti-kickback law Stark law Tax-exempt organizations Anti-trust law

w w w. j a c k s o n k e l l y. c o m 8 Legal Challenges for Integration Prohibition on payments to limit or reduce care False claims law HIPAA Certificate of need law

w w w. j a c k s o n k e l l y. c o m 9 Confidentiality Note: This presentation from the law office of Jackson Kelly PLLC is for the sole use of the intended viewers and contains confidential and privileged information. Any unauthorized review, use, disclosure, distribution, or other dissemination of this presentation and/or the information contained herein in strictly prohibited. QUESTIONS